By Kalvin Pugh
AB 554 is a huge step in the right direction; however, without consistent leadership from policymakers, those living with HIV will continue to be the first on the budget chopping block.
When I learned I was living with HIV nine years ago, there were a lot of questions to be answered: how will I access treatment? Will I feel safe and respected by my care team? What does stigma look like for me in the fourth decade of the HIV epidemic?
While I was fortunate to have a wonderful team of case managers and health care providers who guided me through an unfamiliar and complex medical system, I’ve heard countless stories of people fighting tooth and nail just to find appropriate care, let alone treatment.
Our country’s labyrinthine, convoluted health system is cluttered with obstacles like prior authorization and step therapy. Both of which needlessly delay access to health care by imposing vague requirements and/or forcing patients to “fail” a series of medications before they are granted access to the one actually prescribed by their physician. For game-changing HIV prevention drugs like PrEP, these hurdles endanger lives. Combined with our current federal landscape being incredibly antagonistic (i.e., the Trump Administration trying to gut $1.5 billion in HIV prevention funding, among a laundry list of offenses), the LGBTQ+ community is facing disproportionate hardships that are exacerbating disparities and contributing to further stigmatization.
Thankfully, California policymakers are doing their part to protect our community. Assembly Bill 554, authored by Assemblymember Mark González (D-Los Angeles), follows in the footsteps of nine other states by ensuring coverage for all long-acting, injectable drugs used for PrEP and PEP. The bill “safeguards patient and provider choice” by eliminating cost-sharing and expanding access to a wider range of ARV medications to help bolster medication adherence rates. It also ensures coverage for future formulations of ARV drugs that are better at making HIV undetectable and untransmissible.
PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are effective regimens for preventing the transmission of HIV when taken as prescribed. AB 554 enshrines quick access to these treatments, satisfying calls for health equity, especially for Black and Latino Californians, who face disproportionate transmission and infection rates.
AB 554 is a huge step in the right direction; however, without consistent leadership from policymakers, those living with HIV will continue to be the first on the budget chopping block. Just last week, the California Legislature passed a budget trailer bill (AB 144) that includes provisions to divert funds from the AIDS Drugs Assistance Program Rebate Fund toward general state operations.
California policymakers can’t say they’re countering the Trump Administration and supporting the HIV community if they’re also ripping the rug out from underneath us. AIDS Drug Assistance Programs are lifelines – they normalize diagnoses, fund direct services, and help uninsured and underinsured patients access essential care.
Ironically, while AB 554 will build upon the work of ADAPs to eliminate prohibitive barriers, AB 144 will steal funds from the program to instead boost state revenue. ADAPs already operate from a very small annual revenue of fixed federal funding awards per state. States taking more money away from these critical programs will threaten their ability to serve HIV patients. Moreover, these dollars are statutorily prohibited from being used for non-HIV care by Title II of the Ryan White CARE Act.
California is destined to repeat the sins of the past unless Governor Newsom steps in. For too long, those living with HIV have been isolated, cast aside, leveraged for political gain, and dropped soon thereafter if something better comes along. We are not budget dust, we are not pawns in a political game, we are real people with real voices, and we’re asking Governor Newsom to do what’s right: redline the ADAP provisions from AB 144 and sign AB 554 into law.
California can lead the nation in doing what’s right for all communities. But it starts with policy, and we have to make sure policies are centered around those they impact.
Kalvin Pugh is the state policy director for the Community Access National Network, a national 501(c)(3) nonprofit that works to improve access to health care services and supports for people living with HIV/AIDS and viral hepatitis through advocacy, education and networking.